Analysis of 1000 Protocol Kidney Biopsies: Complications, Benefits, and Predictive Potential of Prior Sensitization

M. Eslami¹, J. Patel², S. Karzai¹, D. T. Collins¹, C. Liu¹, J. Jonsson¹, R. Wali¹, J. B. Piper¹

¹Surgery, Inova Fairfax Hospital, Falls Church, VA, ²General Surgery, Pennsylvania State University, State College, PA

Meeting: 2020 American Transplant Congress

Abstract number: 453

Keywords: HLA antibodies, Kidney transplantation, Post-operative complications, Protocol biopsy

Session Information

Session Name: Kidney Complications: Immune Mediated Late Graft Failure

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

Presentation Time: 4:03pm-4:15pm

Location: Virtual

*Purpose: Protocol biopsy of kidney transplants can allow for early recognition of treatable findings, both immunologic and non-immunologic. This comes with the risk of biopsy complications. The aim of this study was to quantify all outcomes, both beneficial and adverse, and to assess predictive potential of prior sensitization on biopsy outcome.

*Methods: A single-center retrospective analysis of 1000 protocol biopsies (N=439 patients) from 2011-2018 was conducted. Biopsies were performed at 3 months then annually up to 5 years post-transplant. For-cause biopsies were excluded. Endpoints of biopsy-related complications, findings, and pre-transplant DSA were evaluated. Analyses were performed on both patient- and biopsy-level. Biopsy findings were stratified by non-treatable, treatable immunologic, and treatable non-immunologic pathologies. Univariable and multivariable analyses were performed in evaluation of these pathologic endpoints related to patient characteristics.

*Results: Of 1000 protocol biopsies, 46 (4.6%) had a biopsy-related complication, with arteriovenous fistulas being the most common, occurring in 16 of 46. There was no graft loss. 222 (22.2%) had a treatable pathology on biopsy, of which 46 were immunologic, 157 were non-immunologic, and 19 had both. On multivariable analysis for treatable immunologic pathology, positive pre-transplant DSA conferred an OR of 3.07 (CI:1.46-6.42;p=0.003), compared to DSA negative. It conferred an OR of 2.02 regarding any treatable biopsy finding (CI:1.14-3.57;p=0.016).

*Conclusions: The results demonstrate the benefit of protocol biopsies, evidenced by detection of treatable pathologies, which outweigh resultant complications. This benefit increases if treatment is deemed necessary for borderline rejection, which was not considered a treatable finding in this study. The results show DSA is predictive of encountering treatable pathology on protocol biopsy, specifically immunologic pathologies. This may help guide allograft surveillance. Ongoing research in less invasive methods of allograft surveillance, such as plasma-free DNA testing, may further predict allograft pathology.

To cite this abstract in AMA style:

Eslami M, Patel J, Karzai S, Collins DT, Liu C, Jonsson J, Wali R, Piper JB. Analysis of 1000 Protocol Kidney Biopsies: Complications, Benefits, and Predictive Potential of Prior Sensitization [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/analysis-of-1000-protocol-kidney-biopsies-complications-benefits-and-predictive-potential-of-prior-sensitization/. Accessed May 16, 2025.

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